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Sexual and reproductive health rights – particularly of women – are under attack and women’s bodies continue to be the battlegrounds on which ideological battles are fought, with devastating results.

So says the latest report by the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights released last week.

And the gaps in healthcare access the report exposed – 25 years after the International Conference on Population and Development formally recognised that reproductive rights were linked to human rights already protected by internal law – are startling.

The report contends that, worldwide, 25 million unsafe abortions take place, more than 200 million women want to avoid pregnancy but are not using modern contraception, more than 45 million women receive inadequate antenatal care or none at all and more than 30 million women deliver their babies outside a health facility.

It highlights the often-neglected aspect of infertility, showing that as many as 180 million couples worldwide are potentially affected by it, yet there is an absence of political concern, combined with the high cost of assisted reproductive technologies worsening the availability of care.

The commission consists of 16 commissioners from Africa, Asia, Europe, the Middle East, and North and South America – and was launched at the Women’s Jail Atrium at Constitutional Hill in Johannesburg.

It comes at a time when South Africa reels from headlines of women being killed by their intimate partners or suffering extreme violence at the hands of men, a point Dr Richard Horton, editor in chief of prestigious medical journal The Lancet, emphasised.

“When Nelson Mandela was sworn in as president in the country, he said the time of healing wounds had come. Yet 24 years later the killing of women in this country is five times the global rate. Every four hours a woman is killed by her intimate partner.”

Worldwide, however, more than one in three women experiences intimate partner violence or non-partner sexual violence in her lifetime.

And this gender-based violence is one of the factors that prevents women accessing their sexual and reproductive health rights.

The report says progress in the advancement of these rights has been “stymied” because of weak political commitment, inadequate resources, persistent discrimination against women and girls and an unwillingness to address issues related to sexuality openly and comprehensively.

“This report is not just an abstract document published by a medical journal but the lived experiences of women and girls. We don’t want it to be just another report that sits on a website or shelf. We want it to move people to act.

“It’s nothing less than a manifesto for women’s sexual and reproductive rights,” Horton said.

On a global level the commission notes that almost all 4.3 billion people of reproductive age worldwide will have inadequate sexual and reproductive health services in the course of their lives.

It contends that meeting the need for modern contraception, safe abortion and maternal and newborn healthcare in developing regions would cost almost R112 a person a year.

The commissioners say for too long sexual and reproductive health and rights have been treated as a narrow set of siloed health issues, with little recognition of their centrality to people’s overall health and wellbeing.

Activist and executive director of Section 27 Mark Heywood agreed and challenged the commission to involve young women and girls in the discourse, to make it more than just “another conversation” and for countries to actually do things differently.

“Bottom line is that access to pre-exposure prophylaxis is extremely limited in the country, despite what we know about its efficacy.

“Bottom line is access to condoms and accurate information on sex and sexuality in our schools is poor at best and nonexistent in most schools,” Heywood said.

“The bottom line is that it’s 2018 and only now are we drafting a policy on teenage pregnancy in schools and the draft that’s been produced by our department of basic education is disturbing in its understanding of the real issues.

“We’re a country that led the world in 1996 in pioneering legislation on the choice of termination of pregnancy, but we’ve seen a serious regression in access to termination and no attention to that regression in the past 15 years.”

The commission made eight recommendations, starting with countries adopting the definition of sexual and reproductive health and rights in the report; and by supporting the changes in laws, policies and social norms as advised in the report.

They also advocated the expansion of access to essential and integrated packages of sexual and reproductive health services.

“It’s time to eliminate these inequities with a comprehensive approach that doesn’t overlook critical components, such as access to safe and legal abortions, prevention of reproductive cancers or treatment for infertility,” said Alex Ezeh, commission co-chairperson and former executive director of the African Population and Health Research Centre.

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